Clinical and paraclinical characteristics and treatment outcomes of patients with minor stroke admitted within the first 4.5 hours

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The optimal therapeutic approach for patients with minor stroke presenting within 4.5 hours of symptom onset remains a subject of ongoing debate, particularly regarding the efficacy and safety of intravenous thrombolysis with alteplase compared to single (SAPT) or dual antiplatelet therapy (DAPT). We conducted a single-center, observational cohort study involving patients with acute minor stroke (NIHSS ≤ 5) who were admitted within 4.5 hours to the Stroke Center of Bach Mai Hospital. Patients were stratified into three treatment groups: intravenous alteplase, DAPT, and SAPT. The primary outcome was a favorable functional incidence at 90 days, defined as a modified Rankin Scale (mRS) score of 0–1. The results show that among 186 patients (34 alteplase, 119 DAPT, 33 SAPT), the proportions achieving mRS 0–1 at day 90 were 90.4% (79.4%, 96.7%, and 78.8%, respectively). The alteplase group demonstrated a higher baseline NIHSS score (median 4 [IQR: 3.75 – 5]) than the DAPT and SAPT groups (both with a median of 2; p < 0.001). Early neurological deterioration (END) occurred in 38.2% of the alteplase group, 18.2% of the SAPT group, and 0.8% of the DAPT group. END was an associated factor with unfavorable outcomes (mRS 2–6), with an adjusted odds ratio of 2.14 (95% CI: 1.25 – 3.68; p < 0.01). In this single-center observational study, 90.4% of patients with minor stroke achieved favorable functional outcomes at 90th day. The rates of favorable outcomes in the DAPT, alteplase, and SAPT groups were 96.7%, 79.4%, and 78.8%, respectively. Patients treated with alteplase had higher baseline NIHSS scores and a greater frequency of early neurological deterioration, which was associated with poor functional outcomes at 90 days.

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